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, Center for 
Substance Abuse 

Substance Abuse and Mental 
Health Services Administration 

Substance Abuse Resource Guide 






Tobacco use is increasingly becoming taboo in American 
society. Yet, according to statistics from the U.S. Depart- 
ment of Health and Human Services, about 32 percent of 
the total population has used tobacco within the past year, 
and 72 percent of the population has tried tobacco at some 
time throughout the course of their lives. Disturbingly, 36 
percent of 12- to 17-year-old adolescents have already 
tried tobacco. 

Tobacco use remains the leading preventable cause of 
death in the United States, causing more than 419,000 
deaths each year at an annual cost of more than $50 
billion, according to a 1 996 report from the Centers for 
Disease Control and Prevention (CDC). 

The Center for Substance Abuse Prevention recognizes 
the serious threat that chewing and smoking tobacco 
poses to the health of Americans and is committed to 
stemming the tide of new smokers by deterring tobacco's 
use. This guide provides the latest information and refer- 
rals for tobacco use prevention. It highlights research, 
materials, programs, and organizations for prevention 
professionals, educators, parents, and the general public. 
By working together, we can save lives. 

Nelba Chavez, Ph.D. 


Substance Abuse and Mental Health Services Administration 

, ol L. Kumpfer, Ph.D. 
; jctor 

iter for Substance Abuse Prevention 

stance Abuse and Mental Health Services Administration 

Prevention Materials 

Studies, Articles, & Reports 

Groups, Organizations, Programs, 
& Internet Sites 

Substance Abuse and Mental Health Services Administration 
Center for Substance Abuse Prevention 


Prevention Materials for 

Cigarettes Made Them History 

Organization: Tobacco Education 
Clearinghouse of California/ETR 

Year: 1 996 

Format: Poster 

Target Audience: African-American youth 

Availability: Tobacco Education 
Clearinghouse of California/ETR 
Associates, P.O. Box 1 830, Santa Cruz, 
CA 95061-1 830; 408-438-4822, ext. 230. 

Cost: 250 each 

1 his black and white, 14-inch by 15-inch 
poster contains the photographs of three 
African- American recording stars: Mary 
Wells, Eddie Kendricks, and Sarah 
Vaughn. On the poster are the following 
words: "Cigarettes made them history. 
WARNING: Cigarette smoking is the 
leading cause of death among African 
Americans, and it's totally preventable." 

Drugs 101: Nicotine 

Organization: William Gladden Foundation 

Year: 1 994 

Format: Brochure 

Length: 6 pages 

Target Audience: Parents and high-risk youth 

Availability: Continental Press, 520 East 

Bainbridge Street, Elizabethtown, PA 

17022; 800-233-0759, 
Cost: Minimum purchase of 25 @ 440 each 

1 his brochure describes why people 
become addicted to nicotine, what 
nicotine withdrawal is, how using tobacco 
can harm one's health, and how tobacco 
users can quit. 

Enough Snuff: A Guide for 
Quitting Smokeless Tobacco 

Organization: Applied Behavioral Science 

Year: 1 997 
Format: Booklet 
Length: 6 pages 
Target Audience: General public, sr. high 

school youth, young adults 
Availability: Applied Behavioral Science Press, 

1 1 4 Washington Avenue, Point 

Richmond, CA 94801 ; 888-222-7347; 


Cost: $9.95 plus $2 shipping and handling 

per book 

1 his manual is to be used by snuff or 
chewing tobacco users who want to quit. 
It is divided into four steps: (1) Evaluate 
(readiness, motivation use patterns, and 
addiction); (2) Set a quit date and select a 
quit plan; (3) Deal with withdrawal; and 
(4) Maintain. The manual covers a range 
of topics including the reasons tobacco 
users quit, the three ways to quit, and the 
proper use of a nicotine patch or gum. 

Faces of Addiction: Fighting 
Substance Abuse in Your 

Organization: Home Box Office and The 
Robert Wood Johnson Foundation 

Year: 1997 

Format: Package includes videotape, 
brochure, two posters, viewing guide, 
and media handbook. 

Target Audience: Community service groups, 
educators, and parents 

Availability: National Clearinghouse for 

Alcohol and Drug Information, P.O. Box 
2345, Rockville, MD 20847-2345; 

Tobacco Prevention Materials 

Page 1 

Cost: $6 cost recovery fee 


his community action package was 
designed by Home Box Office and The 
Robert Wood Johnson Foundation to help 
communities address their substance 
abuse problems. It includes a videotape 
composite of "Faces of Addiction," the 
three-part HBO special on substance 
abuse that aired on TV in 1997. 

FactFile: Tobacco. Drug Abuse 

Organization: The Bureau For At-Risk Youth 

Year: 1994 

Format: Brochure 

Length: 6 pages 

Target Audience: General public, and A/D 

prevention professionals 
Availability: The Bureau For At-Risk Youth, 1 35 

Dupont Street, P.O. Box 760, Plainview, NY 

11803-0760; 800-999-6884. 
Cost: 49C each 

1 he use of tobacco, whether it is smoked, 
chewed, or inhaled, has a devastating 
effect on health. This brochure educates 
readers about such consequences which 
include respiratory disease, cancer, 
coronary heart disease, and blockage of 
blood vessels. The brochure explains the 
immediate benefits of smoking cessation 
and refers readers to information and 
assistance on smoking cessation. 

Facts About... Nicotine 
Addiction and Cigarettes 

Organization: American Lung Association 

Year: 1995 

Format: Brochure 

Length: 8 pages 

Target Audience: General public 

Availability: American Lung Association; 

Cost: Free 

1 his brochure provides answers to 18 
tobacco-related questions such as "What is 

the link between cigarettes and nicotine?"; 
"How does nicotine work?"; and "What 
are some tips for smokers who decide to 
quit?" Other information addresses the 
effects of the drug and the reasons 
smoking helps people relax. The nicotine 
patch and nicotine chewing gum are also 

The Filthy, Disgusting, Ugly, 
Foul, Hideous, Horrible, Ghastly, 
Nasty, Nauseating Tobacco 

Organization: Journeyworks Publishing 

Year: 1995 

Format: Brochure 

Length: 6 pages 

Target Audience: General public, high-risk 

youth, jr, and sr. high youth 
Availability: Journeyworks Publishing, P.O. Box 

8466, Santa Cruz, CA 95061 ; 408-423- 

Cost: 50 copies tor $1 5 

1 his publication presents a tobacco quiz 
with questions such as "What gross things 
do smokers do?"; "What's the most 
disgusting part about sharing a cigarette 
with a friend?"; and "Did the original 
'Marlboro Man' die of cancer?" 

Five Ways Tobacco Companies 
Try To Trick You 

Organization: Journeyworks Publishing 

Year: 1996 

Format: Brochure 

Length: 6 pages 

Target Audience: Jr, and sr. high youth 

Availability: Journeyworks Publishing, P.O. Box 

8466, Santa Cruz, CA 95061 ; 408-423- 

Cost: 50 copies for $1 5 


feared to young people, this brochure 
explains the influence of tobacco 
advertisements by exposing the tactics 
tobacco companies use in their ads and 
the truths they hide to sell their products. 

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NCADI, P.O. Box 2345, Rockville, MD 20847-2345 

It provides tips for deciphering and 
resisting the messages in ads. 

Free Stuff From Tobacco 

Organization: Journeyworks Publishing 

Year: 1 996 

Format: Brochure 

Length: 6 pages 

Target Audience: Jr. and sr. high school youth 

Availability: Journeyworks Publishing, P.O. Box 

8466, Santa Cruz, CA 95061 ; 408-423- 

Cost: 50 copies for $1 5 

1 his brochure uses a parody of cigarette 
coupons to deliver facts about tobacco's 
harmful effects. It explains how tobacco 
companies give away "free" stuff 
including a free dizzy, sick feeling, and 
one custom tombstone. 

HHS Fact Sheet. Children and 
Tobacco: The Facts 

Organization: Food and Drug Administration 

Year: 1995 

Format: Fact Sheet 

Length: 2 pages 

Target Audience: A/D prevention 

professionals, community service groups, 
educators — grades 6-1 2, general public, 
health care providers, and parents of 
youth ages 12-18. 

Availability: Food and Drug Administration, 
5600 Fishers Lane, Room 1 505, 
Rockville, MD 20857; 301-443-1 1 30. 

Cost: Free 


his fact sheet presents statistics 
concerning children and nicotine 
addiction, the number of deaths caused 
by smoking, and the health care costs 
associated with tobacco. 

JAM— The Performance Edge 

Organization: Center for Substance Abuse 
Prevention and Centers for Disease 
Control and Prevention 

Year: 1995 

Format: Package includes videotape, poster, 
magazine, and teacher's guide 

Target Audience: Jr. high school youth, sr. 
high school youth, and educators 

Availability: National Clearinghouse for 
Alcohol and Drug Information, P.O. Box 
2345, Rockville, MD 20847-2345; 

Cost: Free 

1 his educational program teaches young 
people about the clangers of drinking, 
smoking, and using drugs. The program 
urges youth to say "yes" to peak 
performance on the athletic field, in the 
classroom, and on the job and explains 
how tobacco and alcohol use can destroy 
these activities. 

MediaSharp: Analyzing Tobacco 
& Alcohol Messages 

Organization: Centers for Disease Control 

and Prevention 
Year: 1998 
Format: Package 
Target Audience: Educators, community 

service groups, and prevention 

Availability: Centers for Disease Control and 

Prevention, Office on Smoking and 

Health, 4770 Buford Highway, NW., Mail 

Stop K-50, Atlanta, GA 30341 ; 770-488- 

Cost: Free 


lediaSharp, which consists of a leader's 
guide, worksheets, and a short 
videocassette, is a tool for helping youth 
make healthy choices about tobacco and 
alcohol. The kit emphasizes the 
importance of teaching children to assess, 
analyze, and understand the great 
influence of media in their lives. By 
following the modules and worksheets in 
this package, youth will examine the 
messages given to them on television and 
radio, in magazines and newspapers, and 
in other forms of direct and indirect 

Tobacco Prevention Materials 

Page 3 

Nicotine: Easy To Fall For 

Organization: University of Wisconsin 

Year: 1996 

Format: Fact Sheet 

Length: 2 pages 

Target Audience: High-risk youth 

Availability: Wisconsin Clearinghouse, 

University of Wisconsin-Madison, P.O. Box 
1 468, Madison, Wl 53701 ; 608-263-2797. 

Cost: 25 copies for $9 


he front of this fact sheet shows a 
photograph of a young man pole vaulting 
and on the back it warns about the 
dangers of smoking or chewing tobacco. 
In addition, it warns about the deception 
of tobacco advertising, the physical 
damage nicotine can cause, the dangers of 
chewing tobacco, the addictive nature of 
nicotine, and the damage tobacco smoke 
can do to the planet in terms of pollution. 

No Butts About It. Tobacco 
Pollutes. Stomp Out Tobacco 

Organization: Grafeeties and Company 

International, Inc. 
Year: 1 995 

Format: Bumper Stickers for Shoes 
Target Audience: Elementary and jr. high 

youth, high-risk youth 
Availability: Grafeeties and Company 

International, Inc., 1 730 Blake Street, Suite 

400, Denver, CO 80202; 303-291 -1011; 
Cost: Minimum order: 1 sets; Pricing based 

on total quantity; 10-49 @ $1 each 

1 hese "bumper stickers for shoes" are 
meant to be placed on the back of shoes. 
The stickers read "No Butts," "Tobacco 
Pollutes," "Stomp," and "Out Tobacco." 

Preventing Tobacco Use Among 
Young People. A Report of the 
Surgeon General. At a Glance 

Organization: Centers for Disease Control 

and Prevention 
Year: 1 994 

Format: Brochure 

Length: 4 pages 

Target Audience: A/D prevention 

professionals, educators — grades 5-1 2, 
general public, parents of youth ages 
10-18, and policymakers/administrators 

Availability: Office on Smoking and Health, 
National Center for Chronic Disease 
Prevention and Health Promotion, 
Centers for Disease Control and 
Prevention, 4770 Buford Highway, NE, 
(MSK-50), Atlanta, GA 30341 -3724; 
800-CDC-l 31 1 , 770-488-5705. 

Cost: Free 

1 his brochure provides information and 
facts concerning the use of tobacco 
products by young people, including why 
it is important to keep kids tobacco-free. It 
also explains the effects of smoking on 
young people, discusses the addictive 
nature of tobacco use, offers ways to avoid 
peer pressure to use tobacco, and lists 
youth-related prevention programs that 
are successful. 

Reducing Tobacco Use Among 
Youth: Community-Based 
Approaches: A Community 
Guide. Prevention 
Enhancement Protocols 
Systems (PEPS) 

Organization: Substance Abuse and Mental 
Health Services Administration 

Format: Booklet 

Length: 12 Pages 

Target Audience: A/D prevention 

Professionals, Community service groups, 
general public, parents, and educators 

Availability: National Clearinghouse for 
Alcohol and Drug Information, P.O. Box 
2345, Rockville, MD 20847-2345; 800- 

Cost: Free 


his community guide consists of 
recommendations to enhance local efforts 
to curb tobacco use by minors. It presents 
the facts on current tobacco use by 

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NCADI, P.O. Box 2345, Rockville, MD 20847-2345 

minors, explains what steps the Federal 
Government is taking to ban sales of 
tobacco to minors, and explains the PEPS 
method to determine what prevention 
method is best for a community. The 
guide presents a variety of activities 
people can use in their communities to 
curb tobacco use by minors, and it lists 
organizations that can provide further 

Smokeless Tobacco: Spit It Out! 

Organization: Journeyworks Publishing 

Year: 1 996 

Format: Brochure 

Length: 6 pages 

Target Audience: General public, jr. and sr. 

high youth 
Availability: Journeyworks Publishing, P.O. Box 

8466, Santa Cruz, CA 95061 ; 408-423- 

Cost: 50 copies for $1 5 

Smokeless tobacco is not safer than 
smoking cigarettes; once you get started, 
it's easy to get hooked. Using smokeless 
tobacco wrecks your health. Chewers look 
dirty and disgusting when they are using 
tobacco. These are just some of the facts 
included in this brochure which cites how 
tobacco companies trick people into using 
smokeless tobacco. It dispels the myth 
that all baseball players chew. It also 
includes a quiz on now to resist pressure 
from friends, family, or tobacco 

Smoking and Heart Disease 

Organization: American Heart Association 

Year: 1 993 

Format: Brochure 

Length: 10 pages 

Target Audience: Jr. and sr. high youth, and 

Availability: American Heart Association, 

National Center, 7272 Greenville 

Avenue, Dallas, TX 75231-4596; 800-242- 

Cost: Free 

1 his brochure explains how cigarette 
smokers, as well as nonsmokers who are 
exposed to environmental tobacco smoke, 
are at greater risk of developing heart 
diseases. It reveals how smoking effects 
the heart via circulation problems, 
atherosclerosis, peripheral vascular 
disease, heart attack, angina pectoris, and 
chronic lung disease. Teens who smoke 
increase their risk for heart disease later in 
life. Low-tar and low-nicotine cigarettes 
are discussed. 

SOS News at 6:00 

Organization: Somerville Community Access 

Year: 1995 
Format: Videotape 
Length: 30 Minutes 
Target Audience: High-risk youth and jr, high 

Availability: Landmark Media, 3450 Slade Run 

Drive, Falls Church, VA 22042. 
Cost: $195 

1 his video was made by junior high 
school students in an effort to prevent 
teenage smoking. The video examines 
topics such as tobacco advertising, 
substances that are in cigarettes, second 
hand smoke, and peer pressure 
management. The students conduct 
interviews with physicians, cigarette 
smokers who have quit, and teens who 
smoke. They also present a drama 
portraying a teen dealing with peer 

The Spitting Image: Is Chewing 
Tobacco a Part of the Game? 

Organization: National Federation of State 

High School Associations 
Year: 1994 
Format: Brochure 
Length: 6 pages 
Target Audience: High-risk youth and sr. high 


Tobacco Prevention Materials 

Page 5 

Availability: National Federation of State High 
School Associations, 1 1 724 Plaza Circle. 
P.O. Box 20626, Kansas City, MO 64195; 

Cost: $25 for a set of 1 00 brochures 


his brochure uses the words "spit free" 
to list reasons to avoid chewing tobacco. 
Each letter in the words "spit free" 
corresponds to a sentence beginning with 
that letter. For example, "S" is "safeguard 
your health," "P" is "protect your image," 
and so on. 

The S.T.O.P. Guide (The 
Smokeless Tobacco Outreach 
and Prevention Guide): A 
Comprehensive Directory of 
Smokeless Tobacco Prevention 
and Cessation Resources 

Organization: Applied Behavioral Science 

Year: 1997 

Format: Book 

Length: 284 pages 

Target Audience: A/D prevention and 
treatment professionals, community 
service groups, educators, parents, and 
policymakers, and administrators 

Availability: Applied Behavioral Science Press, 
1 1 4 Washington Avenue, Point 
Richmond, CA 94801 ; 888-222-7347, 

Cost: $89 plus $9 shipping and handling 

1 his nine-chapter guide deals with a 
variety of topics regarding smokeless 
tobacco. The chapters cover the 
prevalence of chewing tobacco use in the 
United States, legislation and litigation of 
chewing tobacco, tobacco industry 
practices, ingredients of chewing tobacco, 
health problems associated with 
smokeless tobacco, school-based 
prevention of smokeless tobacco use, and 
key elements of the "Enough Snuff" 
smokeless cessation program. 

Stop the Sale, Prevent the 

Organization: Center for Substance Abuse 

Year: 1995 

Format: Communications Package 
Target Audience: Prevention professionals, 

community service groups, general 

public, and parents 
Availability: National Clearinghouse for 

Alcohol and Drug Information, P.O. Box 

2345, Rockville, MD 20847-2345; 1-800- 

Cost: Free 


his kit contains fact sheets about the 
advertising industry, the industry's 
promotion of tobacco products to young 
people, trends in tobacco use among 
youth, and nicotine addiction among 
adolescents. The kit also lists things 
people can do to prevent tobacco sales to 
youth under 18 years old. 

Talking Tobacco: What To Say 
and How To Say It 

Organization: Joumeyworks Publishing 

Year: 1996 

Format: Brochure 

Length: 6 pages 

Target Audience: Parents of youth ages 11-18 

Availability: Joumeyworks Publishing, P.O. Box 

8466, Santa Cruz, CA 95061 ; 408-423- 

Cost: 50 copies for $1 5 


his brochure gives adults support and 
guidance for effectively reaching young 
people and helping them make tobacco- 
free choices. It explains how to teach 
young people to say "no" to tobacco, how 
to answer the difficult questions they may 
ask, and how to talk about the real facts 
about tobacco. 

Teens and Tobacco 

Organization: Business and Legal Reports, Inc. 
Year: 1 995 
Format: Booklet 

Page 6 

NCADI, P.O. Box 2345, Rockville, MD 20847-2345 

Target Audience: Jr. and sr. high youth, and 

high-risk youth 
Availability: Business and Legal Reports, Inc., 

39 Academy Street, Madison, CT 06443; 

Cost: Free for single quantity 

1 his booklet parodies several television 
programs such as "Wheel of Misfortune." 
"Deathstyles of the Rich and Ruthless," 
and "Leafis and Smoke-Hed." Each parody 
presents facts about the dangers of using 
tobacco. The last two pages summarize 
some of the facts and present readers with 
a pledge in which they promise to abstain 
from using tobacco products. 

Teens Taking Action! A Guide to 
Conducting Tobacco 
Compliance Checks. 
(Introduction and 
Unconsum mated Version) 

Organization: Substance Abuse and Mental 
Health Services Administration, Center tor 
Substance Abuse Prevention, Public 
Health Service, U.S. Department of Health 
and Human Services, Washington, DC; 

Format: VHS Video 

Length: 23 Minutes 

Target Audience: Community service groups, 
educators, general public, jr. high youth, 
parents, merchants, and police officers 

Availability: National Clearinghouse for 
Alcohol and Drug Information, P.O. Box 
2345, Rockville, MD 20847-2345; 800- 

Cost: Free 

1 his video and its companion guide are 
intended to be used to train teen 
inspectors on how to conduct tobacco sale 
compliance checks. These materials were 
developed as resources for State and local 
agencies that are responsible for 
monitoring sales to minors, as mandated 
by the Synar Regulation. Federal agencies, 
local tobacco enforcement officials, and 
researchers may find these materials 
useful in preparing staff for tobacco outlet 

inspections. In this consummated version 
teen inspectors are shown purchasing 

Tobacco: Don't Be Fooled 

Organization: Journeyworks Publishing 

Year: 1997 

Format: Brochure 

Length: 6 pages 

Target Audience: High risk youth, jr. and sr. 

high youth 
Availability: Journeyworks Publishing, P.O. Box 

8466, Santa Cruz, CA 95061 ; 408-423- 

Cost: 50 copies for $1 5 

In this brochure, two teenagers 
encounter a cigarette poster and begin to 
wonder if they would look more 
appealing if they smoked. Their friends 
discourage them from smoking, pointing 
out that tobacco use will have a negative 
impact on their social lives and budgets, 
among other things. Nine top reasons to 
say "no" to tobacco are listed along with 
an explanation of tobacco companies' 
advertising techniques that target young 

Tobacco Horror Picture Show 

Organization: Discover Films Video 

Year: 1 997 

Format: Videotape 

Target Audience: Jr. and sr. high youth 

Availability: Discover Films Video, P.O. Box 

24758, New Orleans, LA 701 84; 888-649- 

Cost: $149 


his video blends humor and horror in a 
way that will be interesting to young 
people. A mad scientist revels in his lab 
while adding toxic chemicals to his 
cigarettes. A "tar lady" portrays on the 
outside what happens on the inside from 
smoking. This video also features Debi 
Austin, a victim of throat cancer who 
demonstrates the results of nicotine 
addiction when she smokes through the 

Tobacco Prevention Materials 

Page 7 

stoma (hole in her neck) created when her 
larynx was removed. 

Tobacco Marketing to Young 

Organization: INFACT 

Year: 1994 

Format: Fact Sheet 

Length: 2 pages 

Target Audience: General public, parents of 

youth ages 9-1 8, and A/D prevention 

Availability: INFACT, 256 Hanover Street, 

Boston, MA 021 1 3; 61 7-742-4583. 
Web address: 
Cost: Free 

1 his fact sheet explains how the tobacco 
industry specifically targets young people 
in its marketing campaigns. It discusses 
youth-oriented tobacco promotion such as 
the use of cartoon characters, free 
cigarette giveaways, event sponsorship 
(rock concerts and sporting events), and 
"walking billboards" or cigarette-branded 
merchandise. As a result of these 
marketing techniques, youth smoking is 
on the rise and statistics are given 
regarding this rise. 

The Risks of Tobacco Use: A 
Message to Parents and Teens. 
Guidelines for Parents 

Organization: American Academy of 

Year: 1994 

Format: Brochure 

Length: 6 pages 

Target Audience: General public, high-risk 
families and youth, parents of youth 
ages 1-18. 

Availability: American Academy of Pediatrics, 
Division of Publications, 141 Northwest 
Point Boulevard, P.O. Box 927, Elk Grove, 
IL 60009-0927; 708-228-5005. 

Cost: 1 00 copies for $34.95 

1 his brochure explains how smoking is 
harmful to infants and children and how 

advertising influences teens to smoke. The 
brochure also contains statistics reflecting 
the habits of adult smokers and suggests 
consulting a family pediatrician if a parent 
wants to quit smoking. 

Tobacco X-Files 

Organization: Discover Films Video 

Year: 1998 

Format: Videotape 

Target Audience: Jr. and sr. high youth 

Availability: Discover Films Video, P.O. Box 

24758, New Orleans, LA 701 84; 888- 

Cost: $149 

1 his "show and tell" video paints a 
horrific picture of the harsh realities of 
tobacco use. Mixing gross effects with 
testimonials from recovering teenage 
nicotine addicts, as well as head and neck 
cancer victims, the strange, unbelievable, 
and outrageous truths about tobacco use 
are exposed and discussed for youth 

Too Smart To Start, Too Cool To 

Organization: American Cancer Society 

Year: 1996 

Format: Videotape 

Length: 1 7 minutes 

Target Audience: Educators of jr. high youth 

Availability: American Cancer Society, 1 599 

Clifton Road, NE, Atlanta, GA 30329; 

Cost: Free 

1 his video teaches teens about the 
influence of tobacco advertising. An 
interview with a 16-year-old smoker is 
featured; the teen discusses nicotine 
addiction and the difficulty of quitting. 
The video urges viewers to gain control of 
their lives by choosing not to smoke. A 
"Sucker Test" is presented at the end, 
which quizzes the viewer on some of the 
false impressions teens have about 
smoking including the notion that teens 

Page 8 

NCADI, P.O. Box 2345, Rockville, MD 20847-2345 

cannot be harmed by smoking, and that 
the majority of teens smoke. 

Too Smart To Start, Too Cool To 
Smoke Resource Guide 

Organization: American Cancer Society 

Year: 1996 

Format: Classroom material 

Length: 1 2 pages 

Target Audience: Educators of jr. high youth 

Availability: American Cancer Society, 1 599 

Clifton Road, NE, Atlanta, GA 30329 

Cost: Free 

1 his resource guide, to be used in 
conjunction with the video, discusses how 
to use the video to empower teenagers to 
make healthy choices while learning 
valuable life skills. The guide presents 
projects to do with teens to help them 
learn how media manipulation works, 
teaches the facts about tobacco and health, 
provides ways to focus on thinking things 
through and making personal decisions, 
and describes ways to become advocates 
for younger students. 

The Trouble With Tobacco 

Organization: United Learning 

Year: 1 996 

Format: Videotape 

Length: 10 minutes 

Target Audience: Elementary and jr. high 

youth, educators — grades 5-8 
Availability: United Learning, 6633 West 

Howard Street, Niles, IL 60714; 800-424- 

Cost: $79.95 

1 his video shows the stark contrast 
between the fantasy of advertisements 
(which depict smoKing as glamorous, 
relaxing, and fun) and the reality of 
tobacco use (the potential for developing 
health problems such as chronic 
bronchitis, smoker's cough, and 
emphysema). Smoking leaves an odor 
that clings to hair and clothes, disrupts 
airflow in the body, and is also expensive. 

This program identifies poisonous 
chemicals (ammonia, cadmium, and 
pesticides) and gases (such as carbon 
monoxide) in tobacco smoke and how 
they affect the body. Information about 
the hazards of smokeless tobacco is also 

The Trouble With Tobacco- 
Teacher's Guide 

Organization: United Learning 

Year: 1996 

Format: Booklet, comes with videotape 

Length: 14 pages 

Target Audience: Educators — grades 5-8 

Availability: United Learning, 6633 West 

Howard Street, Niles, IL 60714; 800-424- 

Cost: $79.95 


his teacher's guide accompanies the 
video of the same name. It includes a 
program overview, student objectives, a 
suggested lesson plan, previewing and 
post viewing activities, and a transcript of 
the video. 

What s Wrong With Tobacco? 

Organization: Discover Films, Inc. 

Year: 1 995 

Format: Videotape 

Length: 30 Minutes 

Target Audience: Jr. and sr. high youth 

Availability: HRM Video; 1 75 Tompkins 

Avenue, Pleasantville, NY 10570; 800- 

Cost: $189 


his video educates teens about the 
dangers of smoking and using chewing 
tobacco. The video shows how the media 
effects teens and how addictive tobacco is. 
Teens who are addicted to smoking and 
cannot quit are interviewed, as are older 
ex-smokers who lost their vocal cords to 

Tobacco Prevention Materials 

Page 9 

Youth and Tobacco: Preventing 
Tobacco Use Among Young 
People. A Report of the 
Surgeon General 

Organization: Department of Education 

Year: 1995 

Format: Report 

Length: 224 pages 

Target Audience: A/D prevention 

professionals, and parents 
Availability: SAMHSA's National Clearinghouse 

for Alcohol and Drug Information, P.O. 

Box 2345, Rockville, MD 20847-2345; 

Cost: Free 


his is an adaptation of the Surgeon 
General's 1994 report. The excerpts 
included information for educators 
regarding the vulnerability of 10- to-18- 
year-olds to the dangers of smoking. This 
is the approximate age range of future 
users who start smoking, chewing, or 
dipping, and who eventually may become 
addicted to tobacco. 

Page 1 

NCADI, P.O. Box 2345, Rockville, MD 20847-2345 

Studies, Articles, and 

Adolescent Smokers' Provision 
of Tobacco to Other 

Wolfson, M.; Forster. J.L.; Claxton, A. J.: and 

Murray, D.M. 
American Journal of Public Health 
87(4): 649:651, 1997 

1 his study examines adolescent 
smokers' provision of tobacco to other 
adolescents. Data from a survey of 8th-. 
9th-, and lOth-grade students in 
Minnesota is analyzed by using mixed- 
model logistic regression. More than two- 
thirds (68.8 percent) of adolescent 
smokers provided tobacco to other 
adolescents in the previous 30 days. 
Several factors are associated with the 
likelihood of adolescents providing 
cigarettes to others, including having 
parents and friends who smoke, owning 
tobacco merchandise, and making recent 
attempts to purchase cigarettes. 

Analysis Regarding FDA s 
Jurisdiction Over Nicotine 
Containing Cigarettes and 
Smokeless Tobacco Products 

U.S. Dept. of Health and Human Services, 
Food and Drug Administration 

Federal Register 

60(155): 41453-41787, 1995 

1 his three-part document states that 
nicotine's addictive and pharmacological 
properties affect the structure and 
function of the body (within the meaning 
of the definition of a drug), and also 
demonstrates that tobacco manufacturers 
intend their products to have these 
effects. Part one explains why regulation 
of cigarettes and smokeless tobacco 
products as devices is appropriate. Part 

two presents the scientific evidence of 
nicotine's addictive and other 
pharmacological effects. Part two also 
explains how marketed tobacco products 
deliver pharmacologically active doses of 
nicotine and how consumers use these 
products to obtain various drug effects. 
This section describes the statements, 
extensive research, and other actions by 
tobacco manufacturers regarding 
nicotine's pharmacological effects. Part 
three summarizes objectives in regulating 
cigarettes and smokeless tobacco 
products. This section explains why. 
despite the public health problems caused 
by cigarettes and smokeless tobacco 
products, it would not be appropriate to 
remove tobacco products from the market 
because approximately 40 million 
Americans are addicted to them. The 
section summarizes the evidence that 
almost all tobacco use begins during 
childhood or adolescence, and the fact 
that the prevalence of tobacco use by 
children and adolescents is increasing. 
Therefore, the goal of the Food and Drug 
Administration's regulatory action is to 
reduce tobacco use by children and 
teenagers and to prevent future 
generations from becoming addicted to 
nicotine-containing tobacco products. 

Can Cigarette Smoking in 
Young Women Be Prevented By 
Enhanced Spirituality 

Kass, J. 

In: Problems of Drug Dependence 1996: 
Proceedings of the 58th Annual Scientific 
Meeting: The College on Problems of 
Drug Dependence, Inc., NIDA Research 
Monograph Series 1 74. 

Washington, DC: U.S. Government Printing 
Office, 1997. 462 pp. (p. 207) 

Tobacco Prevention Materials 

Page 1 1 

Available from SAMHSA's National 

Clearinghouse for Alcohol and Drug 
Information. P.O. Box 2345, Rockville, MD 
20847; 800-729-6686. 

1 his document examines 54 late- 
adolescent and young-adult females who 
were studied periodically during an 8- 
month period. Researchers measured 
stressors, personality variables, and 
alcohol and cigarette use among the 54 
females initially, again after 5 months, and 
then after 8 months. An initial analysis 
showed that stress regarding physical 
appearance was a risk factor for cigarette 
smoking, but not for alcohol consump- 
tion, while the reverse influence is found 
in terms of the use of these two substances 
and relaxation. Spirituality is a positive 
psychological resource that helps to 
prevent cigarette smoking. Multiple 
regression analysis, which controlled 
cigarette smoking at the start of the study 
and used cigarette smoking at 8 months as 
a dependent variable, identified predictor 
variables. The final model indicates two 
main effects: cigarette smoking at the start 
of the study and an interactive variable 
containing family and friends who smoke, 
current alcohol usage, self-confidence, 
hostility, stress concerning physical 
appearance, and spirituality. 

Cigar Smoking Among 
Teenagers— United States, 
Massachusetts, and New York, 

Morbidity and Mortality Weekly Report 
46(20): 433-440, May 1997 

1 his report presents estimates of the 
prevalence of cigar smoking among youth 
based on analyses of data from the Robert 
Wood Johnson Foundation's (RWJF) 1996 
National Study of Tobacco Price, 
Sensitivity, Behavior, and Attitudes 
Among Teenagers and Young Adults; a 
1996 survey by the Massachusetts 
Department of Public Health (MDPH) of 
high school and junior high students; and 
the Roswell Park Cancer Institute's 1996 

Survey of Alcohol, Tobacco, and Drug Use 
in two New York counties. The analyses 
indicate that during the year before being 
surveyed, 26.7 percent of the Nation and 
28.1 percent of Massachusetts high school 
students reported having smoked at least 
one cigar and that 13-15 percent of ninth 
grade students in two New York counties 
reported having smoked cigars during the 
previous 30 days. If cigar consumption 
continues to increase, cigar-related 
morbidity and mortality can also be 
expected to increase. 

Cigars Move To Replace 
Cigarettes As More Social and 
Politically Acceptable "Nicotine 
Delivery Device" 

Bottom Line on Alcohol in Society 
17(3): 77-83, 1996 


.igars seem to be replacing cigarettes 
among some smokers in America. When 
cigarette smoking decreased after the first 
Surgeon General's report on smoking and 
health in January 1964, millions of 
Americans switched to cigars, producing a 
consumption peak that year at 9.1 billion. 
Kids are still more attracted to cigarettes, 
but the popularity of cigars continues to 
grow. There is no question that cigars can 
cause cancer, even if the smoke is not 
inhaled. Secondhand cigar smoke is every 
bit as harmful as secondhand cigarette 
smoke. Retailers report annual sales 
increases of 50 percent or more for 
premium cigars for the last 2 years. The 
cigar industry estimates that more than 10 
million Americans, 99.9 percent of them 
men, now regularly smoke cigars, an 
increase of about 2 million since 1993. 
Cigar smoking causes cancer of the larynx, 
mouth, esophagus, and lungs. Cigar 
smokers are more likely than nonsmokers 
to develop chronic obstructive lung 
disease, although the risk is lower than 
that of cigarette smokers. 

Page 1 2 

NCADI, P.O. Box 2345, Rockville, MD 20847-2345 

Coronary Heart Disease Risk 
Factors and Cigarette Smoking 
Among Rural African Americans 

Williams, J.; Hunt, D.; and Schorling, J. 
Journal of the National Medical Association 
89(1): 37-47, 1997 

v^igarette smoking is reported to make 
high-density lipoprotein (HDL) 
cholesterol and other cardiac risk factors 
worse, yet no study has examined the 
issue among rural African Americans. This 
study examines the association between 
cigarette smoking and cardiac risk factors 
among rural African-American adults 
from two rural Virginia counties who 
underwent total cholesterol (T), HDL, 
systolic and diastolic blood pressure (SBP 
and DBP), body mass index (BMI), serum 
glucose, and glycosylated hemoglobin 
(GlyHb) measurements. Cross-sectional 
multivariate analyses are used to compare 
risk factors across categories of cigarette 
use. Age, BMI, alcohol consumption, and 
antihypersensitive medication use are 
covariates in the analysis. Results indicate 
that female light smokers have 
significantly lower SBP and DBP, and 
lower HDL. Female heavy smokers have 
significantly lower HDL and BMI and 
significantly higher T/HDL ratios. Male 
heavy smokers have significantly higher 
SBP. More than 33 percent of males and 
more than 50 percent of females are 
overweight. Increasing BMI is associated 
with significantly or nearly significantly 
worsening of all other risk factor levels. 
Both cigarette smoking and obesity 
adversely affect other cardiac risk factors. 
Novel approaches are needed to decrease 
both smoking and obesity in this difficult- 
to-reach population. 

Do as I Say: Parent Smoking, 
Antismoking Socialization, and 
Smoking Onset Among Children 

Jackson, C. and Henriksen, L 
Addictive Behaviors 

22(1): 107-114, 1997 

1 his study examines relationships 
between smoking and antismoking 
practices of parents and early onset of 
smoking among elementary-grade 
children. The parental practices 
investigated are direct modeling of 
cigarette smoking and antismoking 
socialization variables, such as setting 
rules to eliminate cigarette smoking in the 
home, becoming aware of children's 
smoking behaviors, and making clear the 
disciplinary consequences of cigarette 
smoking. From a sample of 1,213 third- 
and fifth-grade children, the study finds 
the following four relationships: (1) 
Children's risk of early onset of smoking 
increases with the level of exposure to 
parent smoking models; (2) If one or both 
parents are current smokers, children who 
have never tried smoking have a 
significantly greater risk of intending to 
smoke — they perceive having easy access 
to cigarettes, and feeling ambivalent about 
smoking; (3) Risk rates for children of 
former smokers indicate that parents' 
quitting smoking does not eradicate the 
effects of parent modeling; (4) Children 
whose parents engage in antismoking 
socialization have significantly lower rates 
of smoking onset, even in parents who are 
current smokers. The implications of these 
results for preventive intervention and 
future research are discussed. 

Do Smokers Understand the 
Mortality Effects of Smoking? 
Evidence From the Health and 
Retirement Survey 

Schoenbaum, M. 
American Journal of Public Health 
87(5): 755-759, 1997 

1 his study examines whether smokers 
recognize that smoking is likely to shorten 
their lives and, if so, whether they 
understand the significance of this fact. 
People's expectations about their chances 
of reaching age 75 are compared with 
epidemiological predictions from life 
tables which identify the following 
categories: "never smoked," "former 
smokers," "current light smokers," and 

Tobacco Prevention Materials 

Page 1 3 

"current heavy smokers." Data on 
expectations of reaching age 75 come from 
the Health and Retirement Survey, a 
national probability sample of adults aged 
50 through 62 years. Predictions come 
from smoking-specific life tables 
constructed from the 1986 National 
Mortality Follow-Back Survey and the 
1985 and 1987 National Health Interview 
Surveys. Among men and women, the 
survival expectations of never, former, 
and current light smokers are close to 
actuarial predictions. However, among 
current heavy smokers, expectations of 
reaching age 75 are nearly twice as high as 
actuarial predictions. These findings 
suggest that at least heavy smokers 
significantly underestimate their risk of 
premature mortality. 

Early Use of Alcohol and 
Tobacco: Its Relation to 
Children's Competence and 
Parents Behavior 

Jackson, C; Henriksen, L; Dickinson, D.; and 

Levine, D. 
American Journal of Public Health 

87(3): 359-364, 1997 

LJ se of tobacco and alcohol during 
childhood predicts heavy use of these 
substances and use of illicit drugs during 
adolescence. This study attempts to 
identify developmental correlates of 
tobacco and alcohol use among 
elementary school children. Cross- 
sectional surveys were used to measure a 
sample of 1,470 third- and fifth-grade 
children with regards to tobacco and 
alcohol use, and to find multiple 
indicators of child competence, parenting 
behaviors, and parental modeling of 
tobacco and alcohol use. Both self-report 
and teacher-rated assessments were 
obtained, which allowed collateral testing 
of study hypotheses. Children's tobacco 
and alcohol use was strongly related to 
low scores on several measures of child 
competence, both self-reported and 
teacher-rated. Tobacco use was also 
associated with less effective parenting 
behaviors and with parental use of 

tobacco and alcohol. The authors 
conclude that children's early experience 
with tobacco and alcohol is associated 
with weak competence development and 
exposure to socialization factors that 
promote risk taking. Interventions to 
prevent early use of tobacco and alcohol 
are needed. 

Effect of Tobacco Tax Cuts on 
Cigarette Smoking in Canada 

Hamilton. V.; Levinton, C; St-Pierre. Y.; and 

Grimara, F. 
Canadian Medical Association Journal 

156(2): 187-191, 1997 

1 his study assesses the effects of the 
tobacco tax cuts made in 1994 on the 
smoking habits of Canadians. This is a 
population-based retrospective cohort 
study. Data from the Survey on Smoking 
in Canada was conducted by Statistics 
Canada on 119 respondents, 15 years of 
age and older. Respondents were 
interviewed about their smoking habits 
approximately every 3 months from 
January 1994 to February 1995. 
Researchers measured changes in 
smoking prevalence, incidence, quit rates, 
and mean number of cigarettes smoked 
per day in the province where tobacco 
taxes were cut and in those where taxes 
were not cut. During the survey, smoking 
prevalence decreased in all provinces, 
whether or not cigarette taxes had been 
cut. However, the prevalence of smoking 
is greater in the provinces where tobacco 
taxes had been cut than in those where 
they had not, and this difference 
increased from 2 percent at the beginning 
of the survey to 3.4 percent at the end 

How Long Will Todays New 
Adolescent Smoker Be Addicted 
to Cigarettes? 

Pierce, J. P.; Gilpin, E. 
American Journal of Public Health 
86(2): 253-256, 1996 

Page 1 4 

NCADI, P.O. Box 2345, Rockville, MD 20847-2345 

1 his study estimates the expected 
smoking duration for young smokers who 
have started recently. Data from National 
Health Interview Surveys are combined to 
model the ages at which smoking 
prevalence declines to various 
percentages of the peak smoking 
prevalence for each successive birth 
cohort. Smoking-cessation ages are then 
estimated for the males and females born 
from 1975 through 1979. The median 
cessation age for those in this cohort who 
start smoking as adolescents is expected to 
be 33 years for males and 37 years for 
females. Thus, 50 percent of these 
adolescent males may smoke for at least 
16 years and 50 percent of these 
adolescent females may smoke for at least 
20 years, based on a median age of 
initiation of 16 to 17 years. Despite the 
decline in the median age of U.S. smokers 
who quit, these data predict that smoking 
will be a long-term addiction for many 
adolescents who start. 

How To Stick to the Real Issues 
in Tobacco Use 

Collins, L. 
Prevention Forum 

17(1): 24, Winter 1997 

1 his document outlines and discusses 
the tactics used by the tobacco industry to 
divert attention away from proven 
tobacco-related threats to public health. 
Initially, the tobacco industry relays 
messages to the public about illicit drug 
use, while ignoring discussions about the 
threats of tobacco-related illnesses. The 
industry also presses issues about tobacco 
regulation interfering with their right to 
free enterprise. Regulation is necessary, 
however, and the tobacco industry must 
cooperate for the good of the public. The 
industry also argues that tobacco 
regulation means the loss of jobs and 
money. However, such regulation has 
been effective at reducing youth tobacco 
use and raising money for jobs and 
educational purposes. While the tobacco 
industry claims to be regulating youth 
access to tobacco, studies show that a 

reduction in young people's access to 
tobacco only occurs when there is 
enforcement, including penalties on store 
owners for selling tobacco to a minor. 
Vendors are held responsible for not 
selling to minors, though the tobacco 
industry claims this is the sole 
responsibility of parents. The industry 
claims that Americans can resolve the 
secondhand smoke problem themselves 
through interpersonal communication; 
however, one study demonstrated that 47 
percent of smokers reported lighting up 
inside public places without asking 
others' consent, while only 4 percent of 
nonsmokers asked a smoker to cease 
using tobacco. 

Identification of Adolescents At 
Risk for Smoking Initiation: 
Validation of a Measure of 

Unger, J.; Johnson, C.A.; Stoddord, J.; 

Nezami, £.; and Chou, C. 
Addictive Behaviors 

22(1): 81-91, 1997 

1 rimary prevention of smoking in 
adolescents requires effective screening 
instruments for identifying those 
adolescents who are most likely to 
experiment with cigarettes. This study 
investigates the predictive value of a 
measure of susceptibility to smoke (the 
lack of a firm commitment not to smoke) 
for predicting smoking initiation 1 and 2 
years later among 687 seventh-grade 
nonsmokers. Results show that 
susceptible adolescents were 
approximately two to three times more 
likely to experiment with cigarettes 
during the ensuing 2 years than were 
nonsusceptible adolescents. At the lower 
levels of smoking, these relationships 
persist even after controlling for 
psychosocial variables. Measures of 
susceptibility to smoke may be an 
effective tool for identifying adolescents at 
increased risk of experimenting with 
cigarettes or assessing their readiness for 
smoking-prevention programs. 

Tobacco Prevention Materials 

Page 1 5 

Implementing the Synar 
Regulation: Strategies for 
Reducing Sales of Tobacco 
Products to Minors. CSAP 
Technical Report 

Available from the U.S. Department of Health 
and Human Services, Public Health 
Service, Substance Abuse and Mental 
Health Services Administration, Rockwall 
II, 5600 Fishers Lane, Rockville, MD 20857 

1 his report contains information to assist 
those who are responsible for reducing 
sales to minors. Included is an analysis of 
current sales rates and case studies of 
States and communities that have 
successfully reduced sales rates. 

Legal and Scientific Basis for 
FDA s Assertion of Jurisdiction 
Over Cigarettes and Smokeless 

Kessler, D.; Barnett, P.; Witt, A; Zeller, M.; and 

Mande, J, 
Journal of the American Medical Association 

277(5): 405-409, 1997 

In August 1996, the U.S. Food and Drug 
Administration (FDA) asserted jurisdiction 
over cigarettes and smokeless tobacco 
under the Federal Food, Drug, and 
Cosmetic Act. Under this Act, a product is 
a drug or device subject to FDA 
jurisdiction if it intends to affect the 
structure or any function of the body. The 
FDA thus determined that nicotine in 
cigarettes and smokeless tobacco does 
affect body structure and function because 
nicotine causes addiction and other 
pharmacological effects. The FDA also 
found that these pharmacological effects 
are intentional because: (1) a scientific 
consensus finds that nicotine is addictive; 
(2) recent studies show that most 
consumers use cigarettes and smokeless 
tobacco for pharmacological purposes, 
including satisfying their addiction to 
nicotine; and (3) newly disclosed evidence 
from the tobacco manufacturers reveals 
that the manufacturers know that nicotine 
causes pharmacological effects, including 

addiction, and design their products to 
provide pharmacologically active doses of 
nicotine. The FDA thus concludes that 
cigarettes and smokeless tobacco are 
subject to FDA jurisdiction because they 
contain a drug — nicotine — and a device 
that delivers this drug to the body. 

Limiting Youth Access to 
Tobacco With the Synar 

Prevention Alert, 27 Feb 1998. 1 p 
Availability: SAMHSA's National Clearinghouse 

for Alcohol and Drug Information, P.O. 

Box 2345, Rockville, MD 20847-2345 

1 he Synar Amendment requires States to 
develop laws barring the distribution of 
tobacco products to minors. The 
legislation, named after its congressional 
sponsor Mike Synar, emphasizes 
consistent enforcement, monitoring of 
retail outlets' compliance, and 
communication or results. The goal of the 
Synar Amendment is that by fiscal year 
2002 a minor attempting to purchase 
tobacco will be able to do so less than 20 
percent of the time. Four States have 
already achieved rates at or below 20 
percent. States that fail to comply with the 
Synar Amendment risk losing between 10 
and 40 percent of Federal block grant 
funds allocated for substance abuse 
prevention and treatment programs, 
depending on the fiscal year involved. 

Long-Term Trends in Cigarette 
Smoking Among Young U.S. 

Escobedo, L. and Peddicord, J. 
Addictive Behaviors 

22(3): 427-430, 1997 

JLvetrospective examination of a national 
probability sample reveals that young 
women, particularly those who dropped 
out of high school, have reached smoking 
rates as high or higher than subgroups of 
young men. These results suggest that 
surveillance, research, and public health 
programs are needed to address the rapid 

Page 1 6 

NCADI, P.O. Box 2345, Rockville, MD 20847-2345 

increase in smoking among young 

National Survey Results on 
Drug Use from the Monitoring 
the Future Study 1975-1995; 
Volume 1, Secondary School 

Johnston, L.D.; O'Malley, P.M.; and 

National Institute on Drug Abuse, 1 996. 

382 pp. 

JLvesults are presented from the 21st 
national survey of drug use and related 
attitudes among American high school 
seniors, the 16th such survey of American 
college students, and the 5th such survey 
of 8th and 10th grade students. Results are 
presented from secondary school samples 
of 8th, 10th, and 12th graders. Two of the 
major topics included in this survey are 
the prevalence of drug use among 
American secondary school students and 
trends in use by those students. Initially, 
11 separate classes of drugs were 
distinguished: marijuana, inhalants, 
hallucinogens, cocaine, heroin, opiates 
other than heroin, stimulants, sedatives, 
tranquilizers, alcohol, and tobacco. 
Separate chapters cover the following 
topics: the students' grade of first use; the 
students' own attitudes and beliefs; the 
related attitudes, beliefs, and behaviors of 
others in the students' social environ- 
ment; and the students' perception of 
drug availability. The study finds that 
large proportions of young people 
establish regular cigarette use during late 
adolescence and that there is a continuing 
increase in cigarette smoking among 
teens. The study also finds that cigarettes 
are a class of substances most frequently 
used daily by high school students. 

New Efforts To Keep 
Adolescents Tobacco- Free 

Journal of the American Medical Association 
275(16): 1218-1219, 1996 

1 he Center for Tobacco-Free Kids is a 
new organization that focuses on 
changing the social environment and that 
attempts to influence public policies 
regarding the use of tobacco t>y teens. The 
center is financed by an initial $30 million 
grant and will collaborate with the 
antismoking efforts of groups such as the 
American Lung Association and the 
American Heart Association. The center 
will assist State and local communities 
that are engaged in tobacco control 
efforts, enabling them to recommend 
changes in policies and practices. This 
assistance will include developing an 
outreach program to broaden and serve as 
a focus for the millions of Americans 
concerned about tobacco control. The 
center is especially interested in focusing 
on teenage smoking because this is when 
the majority of smokers initially become 
addicted to tobacco. 

Patterns of Use of Smokeless 
Tobacco and the 
Unidimensional Model of Drug 

Hu. F.; Hedeker, D.; Day, D.; Flay, B.; and 

Siddiqui, O. 
Addictive Behaviors 

22(2): 257-261, 1997 

1 his study tests whether smokeless 
tobacco (ST) fits a unidimensional model 
of drug involvement (i.e., a model of drug 
use which hypothesizes that early 
experiences with drugs, such as tobacco, 
leads to subsequent use of alcohol, 
marijuana, and other "harder" drugs). The 
study tries to locate ST along the 
dimension that underlies drug use. 
Researchers employ a latent trait analysis 
to quantify drug involvement in a sample 
of high school students. Analyses show 
that although ST use fits the 
unidimensional model of drug 
involvement, the place of ST use along the 
continuum of drug involvement is not 
stable and differs by gender and ethnicity, 
particularly for males. ST use is likely to De 
preceded by soft drug use and followed 
by hard drug use; for females, however, 

Tobacco Prevention Materials 

Page 1 7 

ST use is closely associated with hard 
drug use. The analyses also revealed that 
the fit of the unidimensional model and 
the location of ST use along the dimension 
vary with different ethnic groups. 

Prevalence and Demographic 
Correlates of Symptoms of 
Last- Year Dependence on 
Alcohol, Nicotine, Marijuana, 
and Cocaine in the U.S. 

Kandel, D.; Chen, K.; Warner, L; Kessler, R.: 

and Grant, B. 
Drug and Alcohol Depenaence 

44(1): 11-29, 1997 

1 he prevalence of last-year use of 
alcohol, cigarettes, marijuana, and cocaine 
among the U.S. population and 
conditional prevalence of a proxy measure 
of last-year dependence among last-year 
users of each drug class are assessed as a 
function of age, gender, and ethnicity. 
Analyses are based on three aggregated 
waves (1991, 1992, 1993) of the nationally 
representative samples of the general 
population. An approximation of DSM-IV 
drug-specific last-year dependence for 
each drug class is derived from self- 
reported symptoms of dependence, 
according to data on frequency and 
quantity of use and drug-related 
problems. Descriptive and multivariate 
analyses were conducted. The inclusion of 
cigarettes among the drugs, the large 
number of cases, and the wide age range 
of respondents enabled the authors to 
make drug, age, gender, and ethnic 
comparisons that are not otherwise 
possible in any other data set. The proxy 
measure of dependence, however, nas 
limitations. Among the major findings is 
that nicotine is the most acldictive of the 
four drugs examined. 

Psychosocial and 
Pharmacological Explanations 
of Nicotines "Gateway Drug" 

Lindsay, G.B.; Rainey, J. 

Journal of School Health 
67(4): 123-126, 1997 

Ivesearch shows that adolescent users of 
tobacco are much more likely to use illicit 
drugs than are nonusers of tobacco. This 
article suggests potential psychosocial 
reasons for this progression to other drugs 
based on the following principles of 
learning theory: Theory of Reasoned 
Action, Health Belief Model, and 
Cognitive Dissonance. In addition, a 
neuropharmacology causal mechanism is 
discussed. The existence of tobacco's 
gateway function has important 
implications in the Nation's efforts to 
reduce illicit drug use and adolescent 

Rating Addictiveness: Their 
Effects Aren't as Intense as 
Those of Alcohol, Heroin, or 
Cocaine, But Cigarettes Get Top 
Marks for Their Ability To 
Create Dependence 

Hilts, P.J. 
The Journal 

24(1): 12, 1995 


dthough cigarettes do not offer as 
intense an effect as heroin and cocaine, 
they rank higher in terms of addiction 
based on a number of other factors. 
Cigarettes not only create dependence 
among users, but also elicit a high degree 
of tolerance — the continued need for 
more of a drug to satisfy a craving. In 
smoking, it is not the nicotine or addiction 
that is most harmful but other toxic 
chemicals produced by burning tobacco. 
These chemicals cause most of the 400,000 
deaths in the United States each year that 
are attributed to smoking. Symptoms 
must be present for at least a month or 
must occur repeatedly over a longer 
period of time before dependence is 
considered a probability. Nine criteria are 
listed for determining dependence on a 
psychoactive substance. 

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NCADI, P.O. Box 2345, Rockville, MD 20847-2345 

Rural Teens Start Tobacco Use 

Sever son, H, 
Rural Health News 

Spring 1994. pp. 1,8 


-itizens of rural Idaho surveyed teens at 
a county fair about their tobacco use. 
Chewing tobacco use among white teen 
boys was about 10 percent. Of the 94 
respondents (half were boys), about 56 
percent had tried cigarettes and 33 
percent had tried chewing tobacco. Half 
of current users started before the age of 
12. Only one-third thought it was difficult 
for teens to purchase tobacco in their 
town. The article discusses Oregon Mint 
Chew, a non-tobacco chew, and 
cinnamon and licorice flavored chews. A 
rural dentist is interviewed on mouth 
cancer resulting from chewing tobacco. 

Sociobehavioral Influences on 
Smoking Initiation of Hispanic 

Cowdery, J.; Fitzhugh, E.; and Wang, M. 
Journal of Adolescent Health 
20(1): 46-50, 1997 


he authors studied the sociobehavioral 
influences on smoking initiation of 
Hispanic adolescents for 3 years using a 
national sample. Hispanic adolescents, 
ages 15-22 years, from the 1989 and 1993 
Teenage Attitudes and Practices Surveys 
(TAPS I and II), were selected for analyses. 
Data collected includes measures of 
smoking initiation and attitudes and 
beliefs towards smoking among 
adolescents. Researchers also looked at 
the smoking status of family and peers. At 
the 3-year followup, 43.4 percent of 
nonsmokers at TAPS I had initiated 
smoking. The risk factors associated with 
initiating smoking included having male 
or female friends who smoked and having 
positive attitudes and beliefs toward 
smoking. Parental and sibling smoking 
status has little effect on adolescent 
smoking status. The peer influence on 
Hispanic adolescent smoking is consistent 

with previous research on Caucasian and 
African-American adolescents. The 
formation of attitudes and beliefs toward 
smoking in this population warrants 
further examination, given the influence 
of attitudes and beliefs on smoking 
initiation found in this study. 

States Receive Assistance With 
Synar Regulation Requirements 

Fisher, D.; Carmona, M, 
Prevention Pipeline, March/April 1997. 
pp. 1-4 

1 he Federal Government's recently 
implemented Synar Regulation offers 
States a new challenge and a useful tool in 
the fight to reduce tobacco sales to minors. 
The goal is to reduce the rate of illegal 
purchase by minors to no more than 20 
percent in each State. To assist States and 
territories in implementing the Synar 
Regulation, the Center for Substance 
Abuse Prevention (CSAP) hosted a 
technical assistance workshop in which 
presenters included State administrators, 
local government officials, law 
enforcement officials, researchers, media 
professionals, and community advocates. 
The Synar Regulation requires States to 
enact and enforce laws prohibiting any 
manufacturer, retailer, or distributor from 
selling or distributing tobacco products to 
minors; to conduct random, 
unannounced, annual inspections of a 
sample of tobacco vendors to assess their 
compliance with the State's access law; 
and to submit an annual report to the 
Secretary of Health and Human Services 
describing their enforcement activities, 
their progress in reducing access, and a 
strategy and time frame for achieving a 
non-compliance rate of 20 percent or less. 
The legislation allows for a percentage of 
Federal block grant funds for substance 
abuse prevention to be withheld from 
non-compliant States. 

ToPacco Prevention Materials 

Page 1 9 

Tobacco Use Among U.S. 
Racial/Ethnic Minority Groups— 
A Report of the Surgeon 
General 1998 

Office on Smoking and Health, National 
Center for Chronic Disease Prevention 
and Health Promotion, Centers for 
Disease Control and Prevention, 1 998 

Available from Superintendent of Documents, 
U.S. Government Printing Office, 
Washington, DC 


igarette smoking is a major cause of 
disease and death among African 
Americans, American Indians and Alaska 
Natives, Asian Americans and Pacific 
Islanders, and Hispanics. This report 
provides current information on the risk 
factors and patterns of use within these 
four major ethnic/racial minority groups 
in the United States. American Indians 
and Alaska Natives have the highest 
prevalence of tobacco use among adults 
and African American, and Southeast 
Asian men also have a high prevalence of 
smoking. Among adolescents, cigarette 
smoking prevalence increased in the 
1990' s among African Americans and 
Hispanics. This increase followed several 
years of substantial decline among 
adolescents of all four racial/ethnic 
minority groups. No single factor 
determines patterns of tobacco use among 
racial/ethnic minority groups; these 
patterns are the result of complex 
interactions of multiple factors, such as 
socioeconomic status, cultural 
characteristics, acculturation, stress, 
biological elements, targeted advertising, 
price of tobacco products, and varying 
capacities of communities to mount 
effective tobacco control initiatives. 

Tobacco Use and Usual Source 
of Cigarettes Among High 
School Students— United States, 

Morbidity and Mortality Weekly Report 
45(20): 413-418, 1996 

L^espite laws prohibiting the sale of 
tobacco to minors throughout the United 
States, most minors are still able to 
purchase cigarettes. Researchers analyzed 
data from the 1995 Youth Risk Behavior 
Survey (YRBS) to determine current 
prevalence of cigarette use and smokeless 
tobacco product use by high school 
students, the usual source of cigarettes 
among those who smoked, and the 
percentage of students who were asked to 
show proof of age when buying cigarettes. 
The overall prevalence of current cigarette 
use and frequent cigarette use is 34.8 
percent and 16.1 percent, respectively. 
The prevalence of current cigarette use is 
higher among non-Hispanic white and 
Hispanic students than among non- 
Hispanic black students. The overall 
prevalence of current smokeless tobacco 
use is 11.4 percent. Among students aged 
17 years and younger in grades 9 through 
12 who are current smokers, 38.7 percent 
report that they usually buy cigarettes in a 
store and 2.2 percent buy them from 
vending machines. Male students are 
more likely than female students to report 
that they usually buy cigarettes from a 
vending machine. Students in grade nine 
are more likely, than are students in 
grades 11 or 12, to report that their usual 
source of cigarettes is borrowing from 

Tobacco Use Prevention and 

Vox, S. 

HMO Practice 

9(3): 123-127, 1996 


.any health maintenance organizations 
(HMO's) are implementing comprehen- 
sive efforts in the areas of tobacco use 
prevention and reduction. The HMO 
Group and the Centers for Disease 
Control and Prevention (CDC) co- 
sponsored a working meeting on tobacco 
use prevention and reduction. This 
meeting brought together representatives 
from those groups and State health 
department officials to focus on designing 
plans to accelerate the pace of 

Page 20 

NCADI, P.O. Box 2345, Rockville, MD 20847-2345 

improvement in HMO delivery systems 
and to develop strategies to impact laws 
and policy regarding tobacco control. 
Three areas were identified in which 
government and HMO delivery systems 
can work together: in developing 
guidelines to provide a framework for 
patient care, in gathering information for 
needs assessment and evaluation, and in 
coordinating collaborative intervention 
programs. Most HMO's have clarified 
their smoking cessation mission. Many 
plans measure the results of their efforts. 
HMO's have placed a new emphasis on 
subgroups of smokers who are high risk 
such as adolescents or pregnant women. 
Many plans are improving their internal 
office systems to remind clinicians to 
identify and intervene on the behalf of 
members who smoke. In addition, HMO's 
frequently use the nicotine patch to 
increase members' involvement in 
smoking cessation programs. There are six 
key areas in which HMO's can help 
reduce tobacco consumption by focusing 
efforts on population-based 
environmental and policy approaches. 
They include prevention, treatment, clean 
indoor air, advertising, economic 
incentives, and product regulations. Key 
conference outcomes include developing 
a tobacco use policy; treating smoking 
status as a vital sign, which is measured 
during every visit; implementing 
organized, comprehensive office systems 
to enhance smolking cessation success; 
targeting all HMO members who smoke, 
not just those who come in for care; and 
increasing involvement in public policy 
aimed at decreasing initiation of smoking 
by teens. 

Worldwide Trend: Tobacco Use 
Grows as Low Prices Lure New 
Young Smokers 

Bottom Line on Alcohol in Society 
Spring 1997, pp. 79-91 

1 his article discusses the theme of the 
10th World Conference on Smoking and 
Health held in Beijing, China. The agenda 
includes a focus on the worldwide tobacco 

epidemic. An increase in smoking is 
expected to dramatically increase 
mortality rates. Anti-smoking forces have 
had some notable successes, including 
introducing smoke-free airline flights and 
increasing the number of restaurants with 
nonsmoking sections. Anti-tobacco 
strategies and efforts of France, Canada, 
the United States, Asia, and Great Britain 
are highlighted. 

Tobacco Prevention Materials 

Page 21 

Groups, Organizations 
and Internet Sites on 

Action on Smoking and Health (ASH) 

2013 H Street, NW. 
Washington, DC 20006 
Tel: 202-659-4310 

The Advocacy Institute 

1707 L Street. NW. 
Suite 400 

Washington, DC 20036 
Tel: 202-659-8475 

American Cancer Society 

1599 Clifton Road, NE. 
Atlanta, GA 30329 
Tel: 800-ACS-2345 

American Council for Drug Education 

164 West 74th Street 

New York, NY 10023 

Tel: 800-883-DRUG 


American Heart Association 

7272 Greenville Avenue 
Dallas, TX 75231 
Tel: 214-373-6300 

American Lung Association 

(Consult your local telephone 


Tel: 800-LUNG-USA 

American Medical Association 

515 North State Street 
Chicago, IL 60610 

Tel: 312-464-5000 

Americans for Nonsmokers' Rights 

2530 San Pablo Avenue. Suite J 
Berkeley, CA 94702 
Tel: 510-841-3032 

Centers for Disease Control and 

Prevention (CDC) 

Office on Smoking and Health 

4770 Buford Highway, NW. 

Mail Stop K-50 

Atlanta, GA 30341 

Tel: 770-488-5705, 800-CDC-1311 

Center on Addiction and Substance 
Abuse at Columbia University (CASA) 

152 West 57th Street 

New York, NY 10019 

Tel: 212-841-5200 

Fax: 212-956-8020 

Coalition on Smoking or Health (CSH) 
(legislative information only) 

1150 Connecticut Avenue, NW. 
Suite 820 

Washington, DC 20036 
Tel: 202-452-1184 

Department of Health and Human 

200 Independence Avenue, SW. 
Washington, DC 20201 
Tel: 202-619-0257 

Page 22 

NCADI, P.O. Box 2345, Rockville, MD 20847-2345 

Doctors Ought to Care (DOC) 

5615 Kirby Drive, Suite 440 
Houston, TX 77005 
Tel: 713-528-1487 
Fax: 713-528-2146 

Food and Drug Administration 


Rockville, MD 20857 
Tel: 800-532-4440 

Foundation for a Smokefree America 

264 South La Cienega Boulevard 

Suite 1000 

Beverly Hills, CA 90211 

Tel: 310-277-1111 

Fax: 310-657-1822 

Hazelden Educational Materials 

P.O. Box 176 

Center City, MN 55012-0176 

Tel: 800-328-9000 

The Health Authority 

Indoor Air Quality Information 
Clearinghouse (IAQINFO) 

P.O. Box 37133 
Washington, DC 20013-7133 
Tel: 202-484-1307, 800-438-4318 

Johnson Institute 

7205 Ohms Lane 

Minneapolis, MN 55439-2159 

Tel: 800-231-5165 


Join Together 

A National Resource for Communities 

Fighting Substance Abuse 

441 Stuart Street, 6 th Floor 

Boston, MA 02116 

Tel: 617-437-1500 

http ://w w wj ointogether . org 


Lung Line 

National Asthma Center 
Tel: 800-222-5864 

National Cancer Institute 

Lung Cancer Biology Section 

6130 Executive Plaza, Building 8, Room 


Rockville, MD 20852 

Tel: 301-496-0901 

The National Center for Tobacco-Free 

1707 L Street, NW., Suite 800 
Washington, DC 20036 
Tel: 800-284-KIDS 

National Clearinghouse for Alcohol and 
Drug Information (NCADI) 

P.O. Box 2345 

Rockville, MD 20847 

Tel: 301-468-2600, 800-729-6686 

National Council on Alcoholism and 
Drug Dependence (NCADD) 

12 West 21 st Street 
New York, NY 10010 
Tel: 212-206-6770 

National Families in Action 

2296 Henderson Mill Road, NE. 
Suite 204 

Atlanta, GA 30345 
Tel: 770-934-6364 

National Heart, Lung, and Blood 


Information Center 

P.O. Box 30105 
Bethesda, MD 20824-0105 
Tel: 301-951-3260 

Nicotine Anonymous 

P.O. Box 591777 

San Francisco, CA 94159 

Tel: 415-750-0328 



Tobacco Prevention Materials 

Page 23 

Phoenix Institute 

3459 East Livingston Avenue 
Columbus, OH 43227 
Tel: 800-346-6356 

The QuitNet 

Smokefree (Autonomy Publishing 

P.O. Box 901 
Larchmont, NY 10538 
Tel: 914-698-7947 

Smokescreen Action Network 

The Society for Research on Nicotine and 
Tobacco (SRNT) 

103 South Adams Street 
Rockville, MD 20850 
Tel: 301-251-9133 
Fax: 301-279-6749 

Stop Teenage Addiction to Tobacco 

511 East Columbus Avenue 

Springfield, MA 01105 

Tel: 413-732-7828, 800-998-7828 

Substance Abuse and Mental Health 
Services Administration (SAMHSA) 

Tobacco BBS 

P.O. Box 359 
Village Station 
New York, NY 10014 
Tel: 212-982-4645 

Page 24 -u.s. Government Printing office: 1999-453-254/10421 NCADI, P.O. Box 2345, Rockville, MD 20847-2345 







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DHHS Publication No. (SMA-99) 3231 
Printed 1999